初始 24 针经直肠前列腺活检方案对检出显著前列腺癌和高级别前列腺上皮内瘤变的影响。

The implication of initial 24-core transrectal prostate biopsy protocol on the detection of significant prostate cancer and high grade prostatic intraepithelial neoplasia.

机构信息

Asklepion Voula Hospital, Vasilleos Paulou 1, Athens, Greece.

出版信息

Int Braz J Urol. 2011 Jan-Feb;37(1):87-93; discussion 93. doi: 10.1590/s1677-55382011000100011.

DOI:10.1590/s1677-55382011000100011

PMID:21385484

Abstract

PURPOSE

To assess the diagnostic value of an initial 24-sample transrectal ultrasound guided (TRUS) prostate biopsy protocol compared to the 10-core technique.

MATERIALS AND METHODS

We retrospectively reviewed the prostate biopsy database of consecutive men undergoing prostate biopsies under local anesthesia by using the 10 (Group A) and 24 (Group B) protocols. Men were stratified according to biopsy protocol and PSA levels. Exclusion criteria were age ≥ 75 years and PSA > 20 ng/mL. The Mann-Whitney U and Fisher's exact test were used for statistical analysis.

RESULTS

Between April 2007 and August 2009, 869 men underwent TRUS prostate biopsies of which 379 were eligible for the study. Group A (10-cores) consisted of 243 (64.11%) men and group B (24-cores) included 139 (35.89%) men. The overall prostate cancer detection rate was 39.09% and 34.55% in Group A and B, respectively (p = 0.43). An overall 9.8% increase in Gleason 7 detection rate was found in Group B (p = 0.24). The high-grade prostatic intraepithelial neoplasia (HGPIN) detection rate in men with negative initial biopsies was 15.54% and 35.55% in Group A and B, respectively (p < 0.001). In patients with PSA < 10 ng/mL, the 24-core technique increased Gleason 7 detection rate by 13.4% (p = 0.16) and HGPIN by 23.4% (p = 0.0008), compared to the 10 core technique. The 24-core technique increased the concordance between needle biopsy and prostatectomy specimen compared to 10-core technique (p < 0.002).

CONCLUSIONS

The initial 24-core prostate biopsy protocol did not show any benefit in the detection of prostate cancer compared to the 10-core technique. However, it improved the HGPIN detection and the correlation between biopsy results and radical prostatectomy Gleason score in men with lower PSA levels.

摘要

目的

评估与 10 核技术相比，初始 24 样本经直肠超声引导（TRUS）前列腺活检方案的诊断价值。

材料与方法

我们回顾性分析了在局部麻醉下接受前列腺活检的连续男性的前列腺活检数据库，使用 10 核（A 组）和 24 核（B 组）方案。根据活检方案和 PSA 水平对男性进行分层。排除标准为年龄≥75 岁和 PSA>20ng/mL。使用曼-惠特尼 U 检验和 Fisher 确切检验进行统计分析。

结果

在 2007 年 4 月至 2009 年 8 月期间，869 名男性接受了 TRUS 前列腺活检，其中 379 名符合研究条件。A 组（10 核）包括 243 名（64.11%）男性，B 组（24 核）包括 139 名（35.89%）男性。总体前列腺癌检出率分别为 A 组 39.09%和 B 组 34.55%（p=0.43）。B 组中发现前列腺高级别上皮内瘤变（HGPIN）检出率总体增加 9.8%（p=0.24）。在初始活检阴性的男性中，HGPIN 的检出率分别为 A 组 15.54%和 B 组 35.55%（p<0.001）。在 PSA<10ng/mL 的患者中，与 10 核技术相比，24 核技术增加了 13.4%的 Gleason 7 检出率（p=0.16）和 23.4%的 HGPIN 检出率（p=0.0008）。与 10 核技术相比，24 核技术提高了针芯活检与前列腺切除术标本之间的一致性（p<0.002）。